Objective To observe the clinical sedativelefficacy of Tianwang-Buxin Dan treating chronic obstructive pulmonary disease patients undergoing mechanical ventilation.Methods 97 patients with chronic obstructive pulmonary disease undergoing mechanical ventilation were randomly recruited into a treatment group (47 cases) and a control group (50 cases).The control group was treated with midazolam and fentanyl,and the treatment group were treated by Tianwang-Buxin Dan on the basis of the control group.The amount of medazolam and fentanyl,duration of MV,and incidence of side-effects such as hypotension,bradycardia,delirium,nausea,etc were observed in both groups.Results The expected sedative and analgesia scores were obtained in patients of both groups.Compared with the control group,the patients in the treatment group were easier to be aroused and be kept in sedation and analgesia state,besides the dose of midazolam (μg/kg·h-1) (9.51 ±5.87 vs 20.01 ±6.24,P＜0.01)and fentanyl (μg/kg·h-1) was significantly fewer (0.22 ±0.13 vs 0.32±0.12,P＜0.05),duration of MV (days) was shorter(7.13±6.25 vs 12.85±9.13,P＜0.01),duration of disable sedatives for extubating (hours)was shorter (4.35 ± 2.57 vs 8.79±4.02,P＜0.01),the rates of hypotensionand brdycarcardia were significantly lower,the rates of delirium and nausea were clearly lower(both P＜0.05)in the treatment group.Conclusion Sedative effect of Tianwang-Buxin Dan is satisfactory for patients with chronic obstructive pulmonary disease undergoing mechanical ventilation,with the property of easier arousal,lower hypotension rates,lower brdycarcardia rates,lower delirium rates nausea rates,and fewer dosage of midazolam (by 50％) and fentanyl (by 30％) administration.

Objective To identify the imaging features of pancreatic acinar cell carcinomas.Methods Eleven patients of pancreatic acinar cell carcinomas proven surgically and pathologically were included.We retrospectively evaluated the CT and MR findings including the location, size, shape, margin, necrosis , calcification, hemorrhage, enhancement degree, enhancement pattern, invasion to other organs, perilesional lymph nodes, metastasis, recurrence.Results The tumors were distributed in the head(n=4), body and tail(n=4),tail(n=3) of pancreas.The median tumor size was 97 mm(27 to 180 mm).Nine cases presented with a well-defined enhancing capsule.Tumor vessels could be seen in 9 cases.Seven cases were hypovascular while the other 4 were hypervascular.Different extents of necrosis could be seen in all masses as a swirling or cleft low density in the enhanced tumors, with an median of 10％ (2％ to 25％).The hypovascular masses more frequently demonstrated a lobulated tumor, heterogeneous enhancement pattern, with a larger necrotic component and were more common invasion to other organs.Conclusions Pancreatic acinar ccll carcinoma typically presents as a sizable pancreatic mass with a well-defined enhancing capsule.

Objective To observe the influence of Xiaoshuan enteric-coated Capsule (XSECC) on neuronal damage in cortex of cerebral hypo-perfusion rats. Methods Rats were divided into a sham group (12), a model group (17), a XSECC large dose group (15), a medium dose group (15) and a low dose group (15) by a random number table. The cerebral hypo-perfusion model was produced by permanent bilateral common carotid artery ligation (2VO). The mixed suspension of XSECC was given orally to rats in the XSECC large dose group (420 mg/kg), the medium dose group (140 mg/kg) and the low dose group (47 mg/kg) once each day for 40 days from the beginning of two hour after ischemia. The expressions of NeuN and Caspase-3 were observed by immunofluorescence staining at 40 days after ischemia. The content of GSH-PX,SOD and MDA were measured by biochemical assay. Results Compared to the model group, the expressions of NeuN (8 716.86 ± 2 539.93, 9 549.31 ± 1 663.26 vs. 7 297.05 ± 1 932.49) were significantly increased in the XSECC large dose group and the medium dose group (P<0.05 or P<0.01);The content of GSH-PX (7.37 ± 1.08 U/mg, 7.77 ± 3.26 U/mg vs. 3.67 ± 2.52 U/mg) was increased in the XSECC large dose group and the medium dose group(P<0.05); The expressions of Caspase-3 (11.65 ± 2.68, 14.05 ± 4.55, 12.60 ± 4.56 vs. 16.80 ± 5.41) were obviously decreased in the XSECC large dose group, the medium dose group and the low dose group, compared with the model group (P<0.05 or P<0.01);The content of MDA (1.44 ± 0.40 nmol/mg, 1.96 ± 1.13 nmol/mg, 2.12 ± 1.19 nmol/mg vs. 3.19 ± 0.98 nmol/mg )was decreased in the XSECC large dose group, the medium dose group and the low dose group when compared with the model group (P<0.05 or P<0.01);The content of SOD (555.61 ± 92.45 U/mg, 607.90 ± 228.45 U/mg, 515.98 ± 184.01 U/mg vs. 348.12 ± 108.84 U/mg) was increased in the XSECC large dose group, the medium dose group and the low dose group when compared with the model group (P<0.05 or P<0.01). Conclusion XSECC could protect injured neurons, which is related to the improvement of free radical metabolism.

OBJECTIVE To study the effect of different concentrations of 17-AAG and EGCG monotherapy or in combination on the induced apoptosis in human nasopharyngeal carcinoma, and to explore new molecular targets for the treatment of nasopharyngeal carcinoma. METHODS MTT colorimetric method and fluorescent staining were used to detect the change of CNE proliferation inhibition rate and cell morphology. And furthermore, the expression level of Bcl-2, Bax, Caspase-3 were detected by RT-PCR. RESULTS 1. 17-AAG or EGCG alone had inhibitory effect on the human nasopharyngeal carcinoma CNE cells at 24 h, 48h and 72 h, and it was related with time and dose(P<0.01). The inhibition effect of combination of 17-AAG and EGCG was significantly increased,which was time and dose dependent(P<0.01). 2. RT-PCR was used to detect the mRNA expression level of Bcl-2, Bax and caspase-3. The level of Caspase-3 and Bax mRNA expression after treated by 17-AAG and EGCG was significantly higher, and the level of bcl-2 mRNA expression was lower than that after treated by 17-AAG or EGCG alone. CONCLUSION Our investigation implied that 17-AAG and EGCG in combination can effectively inhibit the proliferation of human nasopharyngeal carcinoma CNE cells. The involved mechanisms may be associated with the upregulation of Bax and Caspase-3 expression.

Objective To investigate the influence of Wenxin granule combined with trimetazidine on inflam-matory factors and cardiac function in patients with chronic heart failure(CHF).Methods From January 2015 to November 2016,100 patients with CHF in Tengnan Hospital of Zaozhuang Mining Industry Group were chosen,and were divided into control group and research group.The control group was treated with trimetazidine,the research group was treated with Wenxin granule on the basis of the control group.After treatment for 6 months,the clinical effects,cardiac function,inflammatory factors and adverse reactions between the two groups were compared.Results The total effective rate of the research group was higher than that of the control group,the difference was statistically significant (90.00% vs.72.00%,χ2＝5.263,P＜0.05).Before treatment,the cardiac function between the two groups had no statistically significant differences(t＝0.062,0.185,0.511,all P＞0.05).After treatment,the LVEF of the research group was higher than that of the control group,the LEVSD and LVEDd of the research group were lower than those of the control group,the differences were statistically significant (t＝12.754,7.936,7.367,all P＜0.05).Before treat-ment,the inflammatory factors between the two groups had no statistically significant differences(t＝0.145,0.156,all P＞0.05).After treatment,the levels of IL－6 and TNF－αof the research group were lower than those of the control group,the differences were statistically significant (t ＝6.366,10.473,all P ＜0.05 ).During the treatment,all patients had no adverse drug reactions such as vomiting,dizziness,irritability,nausea and so on.There was no signifi-cant change in liver and kidney function and hematuria.Conclusion Wenxin granule combined with trimetazidine can furtherly improve the inflammatory reactions and cardiac function of patients with CHF,it is conducive to the improvement of clinical efficacy.

Objective: To summarize the clinical features and genetic analysis results of 10 children with Dent disease. Methods: The clinical data and gene test results of 10 boys aged from 8 months to 12 years with Dent disease diagnosed in Children's Hospital of Nanjing Medical University from January 2014 to July 2017 were analyzed retrospectively. Results: All patients had insidious onset, 5 cases were found to have proteinuria on routine urine examination after hospitalization duo to other diseases, 4 cases were admitted to hospital because increased foams in the urine, and 1 case was found to have proteinuria on health checkup. All cases presented with low molecular weight proteinuria, urine protein electrophoresis showed that the proportion of low molecular weight protein was greater than 50%, 7 cases had nephrotic-range proteinuria, but none had hypoproteinemia. Six cases had hypercalciuria, 3 cases had nephrocalcinosis, 1 case had nephrolithiasis, 2 cases had glomerular microscopic hematuria, in 1 case urine glucose wa weakly positive but blood glucose was normal. All patients had normal renal function, normal serum calcium, no hypophosphoremia and none had rickets. Genetic analysis results showed that 7 patients with variants in the CLCN5 gene, including 2 nonsense variants (p.R637X, p.Y143X), 3 missense variants (p.A540D, p.G135E, p.G703V), 1 deletion variant (exons 9, 10, 11, 12, 13, 1 missing), and 1 frameshift variant (p.T260Tfs*10). Three cases had missense variants of OCRL gene (p.I274T, p.I371T, p.F399S). Except for p.R637X and p.I274T, the other 8 cases had newly discovered variants. Five patients underwent a renal biopsy, the biopsy revealed focal global glomerulosclerosis in 3 patients, mild mesangial proliferative glomerulonephritis in 1 patient and renal minimal change in 1 patient. Mild focal tubular atrophy and interstitial fibrosis were noted in three cases. Mild segmental foot process effacement was noted under electron microscope in all five cases. Conclusions All the children with Dent disease had insidious onset, low molecular weight proteinuria is the main clinical manifestation, most cases presented with nephrotic-range proteinuria, but there was no hypoalbuminemia, some cases were not associated with hypercalciuria. The pathogenic genes in most cases were CLCN5 and a few were OCRL. The types of genetic variation include missense variant, nonsense variant, deletion variant and frameshift variant. Although Dent disease is a renal tubular disease, renal biopsy suggests that most cases are associated with glomerular lesions.

Objective To analyze the predictive effect of miRNA-let-7 combined with serum markers on the chemotherapy effect and prognosis of glioma(GBM)patients.Methods We collected the data of 25 patients with GBM.Twenty healthy volunteers were included as the control group.Fasting serum samples were collected.The levels of let-7b,let-7d,and let-7e in serum samples were analyzed by quantitative real-time PCR.Results Compared with the control group,the levels of let-7b(192.5±18.71 vs.98.13±11.68,t=6.42,P<0.0001)and let-7d(82.9±14.14 vs.44.62±6.83,t=2.41,P<0.05)and let-7e(139.60±14.62 vs.75.86±9.72,t=5.45,P<0.001)in the peripheral blood of patients in the GBM group decreased significantly.The let-7b and let-7e levels significantly decreased in GBM patients over 60 years old,with tumor size over 5 cm,non-frontotemporal lesions,and ECOG of 2,who underwent biopsy alone(P<0.05).The levels of let-7b and let-7e significantly differed among GBM patients with various types of treatment response(P<0.05).The OS of GBM patients with high expression of let-7b and let-7e was higher than that of patients with low let-7b and let-7e expression(P<0.05).Conclusion The expression of let-7b and let-7e in blood samples can be used to monitor GBM and predict patients'response to treatment and prognosis.

Objective:To investigate the effect of acupoint application combined with modified electroconvulsive therapy (MECT) on life control in patients with bipolar disorder.Methods:A total of 98 patients with bipolar disorder who received treatment in The Third People's Hospital of Huzhou from January to December 2022 were included in this study. They were randomly divided into a control group and an observation group ( n = 49 per group). The control group received acupoint application, while the observation group received acupoint application combined with MECT. All patients were treated for 2 weeks. Before and after treatment, Personal Mastery Scale (PMS), Self-Perceived Burden Scale (SPBS), Perceived Social Support Scale (PSSS), and Bipolar Disorder Self-rating Questionnaire (BSQ) scores were compared between the two groups. The severity of the disease and clinical efficacy were assessed in each group. Results:Before treatment, there were no significant differences in PMS, SPBS, and PSSS scores between the two groups (all P > 0.05). After treatment, PMS scores in the observation and control groups were (31.2 ± 4.5) points and (27.8 ± 4.1) points, respectively, and PSSS scores in the two groups were (66.6 ± 12.3) points and (63.2 ± 10.1) points, respectively. After treatment, PMS and PSSS scores in the observation and control groups were significantly increased compared with those measured before treatment in the corresponding groups [observation group: PMS score (15.6 ± 3.3) points, PSSS score (32.1 ± 6.2) points, control group: PMS score (15.2 ± 3.1) points, PSSS score (34.7 ± 6.6) points, t = 20.50, 16.23, 17.53, 16.54, all P < 0.05]. After treatment, SPBS scores in the observation and control groups [(16.2 ± 3.4) points, (17.7 ± 3.6) points] were significantly decreased compared with those measured before treatment in the corresponding groups [observation group: (30.9 ± 5.8) points, control group: (28.1 ± 5.5) points, t = 15.31, 11.07, both P < 0.05]. After treatment, PMS score in the observation group was significantly higher than that in the control group ( t = 4.45, P < 0.05). Before treatment, there was no significant difference in BSQ score between the two groups ( P > 0.05). After treatment, BSQ scores in the observation and control groups [(14.6 ± 6.5) points, (20.1 ± 7.5) points] were significantly decreased compared with those measured before treatment in the corresponding groups [observation group: (39.5 ± 10.2) points, control group: (36.4 ± 9.5) points, t = 12.32, 21.20, both P < 0.05]. After treatment, BSQ score in the observation group was significantly lower than that in the control group ( t = 5.60, P < 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( χ2 = 4.90, P < 0.05). The Spearman test showed a significant negative correlation between PMS and BSQ scores ( r = -0.689, P < 0.05). Conclusion:Acupoint application combined with MECT therapy can improve life control in patients with bipolar disorder and increase clinical efficacy .

Objective:To construct an evaluation index system for the core competence of emergency medical dispatchers, so as to provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.Methods:In September 2022, a research group was established to compile the first draft of the evaluation index system for the core competencies of emergency medical dispatchers through literature review, semi-structured interviews and group discussions. From October to November 2022, a total of 27 experts in related fields from nine provinces and municipalities directly under the Central Government in China were consulted by Delphi expert letters, items were screened and amended, and an evaluation index system for the core competence of emergency medical dispatchers was formed.Results:A total of two rounds of correspondence were conducted. The effective recovery rate of the questionnaire was 100%, and the authority coefficient of the experts was 0.856. Kendall's coordination coefficients were 0.402 and 0.414 ( P<0.01), respectively. Finally, a core competency evaluation index system for emergency medical dispatchers was constructed, which included seven primary indicators, 16 secondary indicators and 75 tertiary indicators. Conclusions:The core competence evaluation index system for emergency medical dispatchers is scientific, reliable and comprehensive, which can provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.

Objective:To retrieve, screen, evaluate and synthesize evidence related to the management of pregnant women during pregnancy after cervical cerclage to provide a basis for clinical practice.Methods:According to the "6S" evidence resource pyramid model, the system searched of all evidence on the management of pregnant women after cervical cerclage in databases suchas UpTo Date, BMJ Best Clinical Practice, International Guidelines Network, American Guidelines Network, World Health Organization website, Yimaitong, Metz Medical website, Clinical Guidelines website, American College of Obstetricians and Gynaecologists, Royal College of Obstetricians and Gynaecologists of the United Kingdom, Canadian College of Obstetricians and Gynaecologists, French College of Obstetricians and Gynaecologists, European Association of Perinatal Medicine, Cochrane Library, the Joanna Briggs Institute (JBI), the Centre for Evidence-Based Health Care Database, PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database, including best dicision practices, guidelines, expert consensus, evidence summary, systematic reviews, Meta-analysis. The search time limit was the establishment of the database to March 1, 2023, and the evidence was extracted and summarized according to the theme after the two researchers independently evaluate the quality of the literature.Results:A total of 8 studies were selected, including 2 expert consensuses, 2 systematic reviews and 4 guidelines. Through literature reading, evidence extraction and classification, 23 pieces of best evidence were summarized from seven aspects: systematic management, activity management, medication management, health behavior management, pregnancy supervision, supervision of the timing of cerclage removal and supervision of psychological state.Conclusions:The best evidence quality and autuority of pregnancy management for pregnamt women after cervical cerclage surgery summarized in the study are high. It was recommended to strengthen the management of pregnant women during pregnancy after cervical cerclage, dynamically and continuously assess the pregnancy status of pregnant women, and prudently selected evidence to improve the prenatal examination process, ensure the safety of mothers and babies, and reduce the occurrence of complications. Overall, effective management of pregnant women during pregnancy after cervical cerclage required a combination of many factors to ensure the health and safety of the mother and baby.